Jaw Surgery Forums » During-Surgery Questions

Adding vertical height to upper jaw?

(10 posts)
  • Started 5 months ago by doggydog
  • Latest reply from sharptoys

  1. doggydog
    Member

    I only show about 4mm of my upper smile when I smile. My lower teeth show all of their height, all the way to the gum line, but in order to see my gum line on my upper teeth I'd have to physically pull my upper lip up quite a lot.

    I feel like my underbite is a weird case. I can't imagine why my surgeon thinks that only moving my upper jaw "forward" would result in showing all of my upper teeth post-surgery. In every case I've seen where the upper jaw has been moved forward, never is there any additional "height" to their upper smile. The smile and the gum line always meet the same as before. (by the way, my lower jaw is not being moved since it has grown properly, my upper jaw is just too far back apparently, resulting in an underbite).

    I truly feel as if he actually needs to add height to my upper jaw, but I can't seem to find any cases of this on the internet. I will be asking my surgeon about all these concerns of mine in a few days when I see him, but for now its starting to confuse me a lot more as of late, probably because surgery is getting closer for me now. I just want to make sure the end result of my surgery is that I look "better" and not "weird". A functional bite is not my goal here really, it is mainly a cosmetic thing. Even if my teeth fit together perfectly I'd still be living with what I refer to as the opposite of a gummy smile (a very short smile), and that is not what I want out of my surgery.

    I'll try to remember to post back here about what my surgeon says about it, but I have the feeling he'll just say what he said last time - that the skin is like a curtain and if a jaw is pushed forward through the curtain the teeth will reveal more. However, I have tried to process this logic and physically it seems impossible for that alone to add height to a smile, due to the lip being attached to the upper jaw through tissue and the movement will remain constricted at the same position in conjunction with one another. Maybe I'm missing something...

    Anyone know a thing or two about this topic? Has anyone had your upper jaw moved vertically downward? Has anyone noticed your upper smile to have additional "height" to it after having your upper jaw moved in a "forward" direction (not "down")?

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    Posted 5 months ago #

  2. ocmama2four
    Moderator

    I haven't had any of those movements but did you ask him for pics of past patients he has had the experience with? If he knows what he is talking about he should be able to give you an example to put your mind at ease.

    I had a 2 piece LeFort 1 that widened my upper jaw 3-4mm, my upper jaw was shortened by 6mm to reduce my gummy smile, pushed back 3mm and tilted up in the back. My lower jaw was pushed back 3mm. Surgery was December 1, 2011
    http://www.jennsjawsurgery.blogspot.com
    Posted 5 months ago #

  3. doggydog
    Member

    He showed me a photo of one person, however I couldn't tell if it was before or after surgery, and I was a being a bit reserved and regret not asking him (I thought it was a stupid question to ask), the guy in the photo had big spaces between his teeth but his jaw structure looked ok. I think I'll have to ask him about something more similar to my case, but its looking like there isn't any really. It's heaps confusing for me in this situation, not really knowing how the surgery "should" be approached.e

    Posted 5 months ago #

  4. SST
    Member

    Hi doggydog, I had jaw surgery for exactly what you describe in May of 2011. In fact, you can probably find some of my older posts here. I had my top jaw broken and moved down 7 mm with a bone graft inserted. It was also moved forward (along with my bottom jaw) 2 mm. If you are looking for more tooth show when speaking or at rest, you definitely need a downward movement of your top jaw. Moving it forward only will not give you that...although it will give you increased lip support.

    I have had some complications with my surgery..i did it only for aesthetics but now have a functional problem which I am trying to fix through braces. Hope that helps.

    Posted 5 months ago #

  5. doggydog
    Member

    SST, do you have any before/after photos? They would really be helpful to me. Perhaps you can show me them privately if you don't want everyone to see them?

    I'm going to mention to my surgeon about what you've said. I have braces on already for a long time now but I wonder if they are in the correct position needed for a vertical movement or not. It's actually more concerning now after reading this because it kind of confirms my suspicions and so I'm wondering what my surgeon is thinking here, I clearly told him what I wanted as an end result of this surgery, I'm not sure how he plans on doing it without a vertical movement.

    Although, there is one difference here. My upper jaw does need to be brought forward more than 2mm. It has to be moved, I'd guess, about 8-10mm to be in front of my lower jaw teeth and fit properly. Perhaps with this much distance it will force my lip to move higher up potentially revealing more teeth. But still, I haven't noticed that affect with anyone else with upper jaw surgery so that idea sounds incorrect to me.

    I'll try to post back here with what he says. My appointment is in a couple of days time.

    Posted 5 months ago #

  6. doggydog
    Member

    I forgot to mention in case you could send me your before/after photos, my email address: doggydogz[at]mail.com

    Posted 5 months ago #

  7. doggydog
    Member

    I had a consult today and he explained that he will move my jaw forward and down at an angle. He also said he cannot tell me exactly how much extra height to my upper teeth I will be able to show when smiling. He explained that a vertical movement requiring a bone graft is basically a less stable option and he didn't seem to want to do it that way, and he said something about the possibility that the bone from the bone graft might "shrink" and my jaw could go back "upwards" meaning a second surgery would then be needed.

    The thing is, the way he wants to do it (a diagonal forward movement) he said that I won't show all of my teeth, as-in up to the gum line, which is kind of what I think would look best when smiling from a cosmetic view, so I'm really confused about what to have done exactly. Should I push to do the more riskier option to get those extra mm of height to my smile? I don't even know how many mm of height I'd have if he did it the way he wants to do it, because he said there's a lot of things in the face that need to adjust and in the end nobody would really know how my smile will ultimately look. I know I'll get some cosmetic improvement to my face/profile from the surgery but I might not get that perfect looking smile I'm aiming for.

    Either way, it turns out I won't be ready for surgery for even longer now because my teeth aren't in place yet, so I have to go back in April for my consult and after that it's another 2 months or so until the actual surgery date. Wow, I never thought it would take THIS long just to have my actual surgery. If I have surgery in July next year that's 2.5 years after I had my braces put on. I'm getting really depressed about it at the moment, trying to cheer myself up as I was looking forward to getting surgery done soon.

    I wonder if there are any non-surgical ways to add height to a smile if it turns out I can't get my jaw moved downward enough? I don't want to look like I have a short smile when this is all done so I really need to try and figure out this strange problem of mine. Hmm...

    Posted 5 months ago #

  8. doggydog
    Member

    UPDATE

    I just found this page which has a diagram of upper jaw surgery movement which looks as if it would both push forward and lower the upper jaw. I have a feeling my surgeon was actually talking about this particular movement for my surgery, which would possibly add height to my upper jaw as I want, however my concerns are still present as to how much upper teeth would show post-surgery (currently I show only 3mm which is unattractive - I want to show the ideal amount which is all the teeth up to the gum line, without showing much gum).

    Image I'm referring to:

    (however it doesn't mention if this is Lefort 1, as I definitely don't need Lefort 2 or 3 which are for more serious facial deformities)

    Site found image on: http://www.mayoclinic.org/jaw-surgery/types.html

    So yeah, in my case I have both an underbite plus what the site says:

    ...deficiency in upper jaw vertical height (...too little tooth-show)

    Posted 5 months ago #

  9. Nature
    Member

    first of all sorry for my english! Hi doggydog and Sst. On one hand im very happy to know that there are people with exactley the same problem as i have.. on the otherhand im sorry to have said that. Actually i have had lower jaw surgey when is was 21 (for underbite). very happy with the result. but never new that i could fix the other problem (lack of showing theeth which botherd me all my life) with upperjaw surgery untill few months ago when a plastic surgion told me so. so here i am! 31 now. already went to the same doctor who operated me previousley. and waiting for the inssurance company to give an OK. I think like you, i would like to have mine upperjaw moved forward and downward. i know (i think) that Babydoll, Ssst and doggydog have the same thing. I would realy like to have some pictures to see wether theeth show has been accomplished. and what changes to the face happend. because for me it is PURE ESTITICS...although im very happy with my face when my mouth is closed.. but just dont'd dare to laugh. So the thing is.. because i like my face as it is.. I probably would find my new face less atractive.. but i can live with a less atractive face IFF my smile improves... so that"s the problem.. i would love to see your picture before an after? or any advise you have. thanks

    Posted 1 month ago #

  10. sharptoys
    Member

    Your surgeon is correct. While superior impaction and/or advancement of the maxilla has been shown to be among the most stable orthognathic operations, inferior (downward) movement of the maxilla is, in general, highly unstable, and one of the few maxilla operations with a significant tendency towards relapse. From the surgeon's perspective, the potential benefits of the surgery (small change in smile)are far outweighed in most cases by the almost definite potential for significant relapse. In the few cases such an operation is indicated, the orthognathic problem almost always stems from significant birth defects/ deforming trauma.

    I understand this is not something that you necessarily want to hear, but your surgeons suggestion of tilting/advancing your upper jaw has a much higher likelihood of producing satisfying and stable aesthetic outcome.

    -Toys

    Posted 1 month ago #

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